Hasselbalch Hans, Skov Vibe, Kjær Lasse, Larsen Morten Kranker, Knudsen Trine A, Lucijanić Marko, Kusec Rajko
Department of Hematology, Zealand University, 4000 Roskilde, Denmark.
Department of Hematology, University Hospital Dubrava, 10000 Zagreb, Croatia.
Cancers (Basel). 2022 Nov 9;14(22):5495. doi: 10.3390/cancers14225495.
About 30 years ago, the first clinical trials of the safety and efficacy of recombinant interferon-α2 (rIFN-α2) were performed. Since then, several single-arm studies have shown rIFN-α2 to be a highly potent anticancer agent against several cancer types. Unfortunately, however, a high toxicity profile in early studies with rIFN-α2 -among other reasons likely due to the high dosages being used-disqualified rIFN-α2, which was accordingly replaced with competitive drugs that might at first glance look more attractive to clinicians. Later, pegylated IFN-α2a (Pegasys) and pegylated IFN-α2b (PegIntron) were introduced, which have since been reported to be better tolerated due to reduced toxicity. Today, treatment with rIFN-α2 is virtually outdated in non-hematological cancers, where other immunotherapies-e.g., immune-checkpoint inhibitors-are routinely used in several cancer types and are being intensively investigated in others, either as monotherapy or in combination with immunomodulatory agents, although only rarely in combination with rIFN-α2. Within the hematological malignancies, rIFN-α2 has been used off-label for decades in patients with Philadelphia-negative chronic myeloproliferative neoplasms (MPNs)-i.e., essential thrombocythemia, polycythemia vera, and myelofibrosis-and in recent years rIFN-α2 has been revived with the marketing of ropeginterferon-α2b (Besremi) for the treatment of polycythemia vera patients. Additionally, rIFN-α2 has been revived for the treatment of chronic myelogenous leukemia in combination with tyrosine kinase inhibitors. Another rIFN formulation-recombinant interferon-β (rIFN-β)-has been used for decades in the treatment of multiple sclerosis but has never been studied as a potential agent to be used in patients with MPNs, although several studies and reviews have repeatedly described rIFN-β as an effective anticancer agent as well. In this paper, we describe the rationales and perspectives for launching studies on the safety and efficacy of rIFN-β in patients with MPNs.
大约30年前,进行了重组干扰素-α2(rIFN-α2)安全性和有效性的首批临床试验。从那时起,多项单臂研究表明rIFN-α2是一种针对多种癌症类型的高效抗癌药物。然而,不幸的是,在早期rIFN-α2研究中显示出高毒性——除其他原因外,可能是由于使用的剂量过高——这使rIFN-α2失去了资格,因此被更具竞争力的药物所取代,乍一看,这些药物对临床医生可能更具吸引力。后来,聚乙二醇化干扰素-α2a(派罗欣)和聚乙二醇化干扰素-α2b(佩乐能)被引入,此后据报道由于毒性降低,它们的耐受性更好。如今,在非血液系统癌症中,使用rIFN-α2进行治疗实际上已过时,在几种癌症类型中,其他免疫疗法——例如免疫检查点抑制剂——已常规使用,并且在其他癌症类型中正在进行深入研究,无论是作为单一疗法还是与免疫调节剂联合使用,尽管很少与rIFN-α2联合使用。在血液系统恶性肿瘤中,rIFN-α2已在费城染色体阴性的慢性骨髓增殖性肿瘤(MPN)患者中作为非标签药物使用了数十年——即原发性血小板增多症、真性红细胞增多症和骨髓纤维化——近年来,随着用于治疗真性红细胞增多症患者的聚乙二醇化重组人干扰素-α2b(贝林妥欧单抗)上市,rIFN-α2得以复兴。此外,rIFN-α2与酪氨酸激酶抑制剂联合用于治疗慢性粒细胞白血病也得以复兴。另一种rIFN制剂——重组干扰素-β(rIFN-β)——已用于治疗多发性硬化症数十年,但从未作为潜在药物在MPN患者中进行研究,尽管多项研究和综述多次将rIFN-β描述为一种有效的抗癌药物。在本文中,我们描述了开展rIFN-β在MPN患者中安全性和有效性研究的基本原理和前景。